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PCV33 Study on Hospitalization Costs for Patients with Atrial Fibrillation Related Stroke in China
VALUE IN HEALTH 15 (2012) A1–A256
OBJECTIVES: To examine the association of missed diagnoses with patient, ED, and hospital characteristics using administrative data METHODS: We conducted a retrospective analysis of missed stroke diagnosis using linked inpatient discharge and ED visit records from the 2009 HCUP State Inpatient Databases (SID) and 2008 and 2009 HCUP State Emergency Department Databases (SEDD). This study was set in inpatient facilities and emergency departments in nine states (CA, FL, HI, MA, MO, NE, NY, SC, TN). We identified patients who were admitted for stroke and had a “treat and release” ED visit in the prior 30 days for a benign headache or dizziness. We excluded stroke admissions for patients under 18 years and for certain other admissions (not occurring through the ED; occurring in facilities with fewer than seven total stroke admissions during 2009; and with missing covariate values). RESULTS: Males (OR⫽0.75; p ⬍0.001) and older individuals (compared to 18-44, 45-64: OR⫽0.43; 65-74: OR⫽0.28; 75⫹: OR⫽0.19; p⬍.001) had lower odds, while Blacks (OR⫽1.17; p⬍.03), Asian/Pacific Islanders (OR⫽1.29; p⬍0.03), and Hispanics (OR⫽1.30; p⬍0.001) had higher odds of a missed stroke diagnosis. Medicare (OR⫽0.66; p ⬍.001) and Medicaid (OR⫽0.70; p ⬍0.001) patients had lower odds of a missed diagnosis compared to privately-insured patients. Non-teaching hospitals (OR⫽1.45; p⬍0.002) and hospitals with low volume (OR⫽1.57; p⬍0.008) had higher odds of a missed diagnosis. CONCLUSIONS: Physicians in the ED who are evaluating patients with headache and dizziness might want to be more attuned to the possibility of stroke in women, younger patients, and nonwhite patients. CARDIOVASCULAR DISORDERS – Cost Studies PCV30 ANALYSIS OF GENERIC SIMVASTATIN AND ATORVASTATIN VERSUS BRANDED ROSUVASTATIN IN HYPERLIPIDEMIA PATIENTS: A BUDGET IMPACT MODEL FROM A MANAGED CARE ORGANIZATION PERSPECTIVE IN THE UNITED STATES Ruff L1, Montouchet C1, Balu S2 1 Medaxial Group, London, UK, 2AstraZeneca Pharmaceuticals LP, Wilmington, DE, USA
OBJECTIVES: Hyperlipidemic patients at risk of cardiovascular (CV) events who receive simvastatin or atorvastatin as a first-line treatment may be less likely to meet low-density lipoprotein cholesterol (LDL-C) goals and thus more likely to experience CV events than patients who initiate on rosuvastatin. A deterministic model was developed to estimate the budget impact over 3 years of initiating high-risk patients in a hypothetical managed health care (MHC) plan on rosuvastatin rather than simvastatin or atorvastatin. METHODS: Among 1,000,000 health plan members aged ⱖ18 years, 1,000 patients (0.1%) were assumed to initiate statins. The average baseline LDL-C level was 160 mg/dL. Two scenarios were modeled: in scenario 1 all patients were initiated on simvastatin or atorvastatin and titrated to a higher dose, or switched to atorvastatin (if initiated on simvastatin) or rosuvastatin; in scenario 2, 50% of the 530 high-risk patients – based on National Cholesterol Education Program (NCEP) guidelines – were initiated on rosuvastatin. Product labeling, clinical trial results, national prescription claims data, and published literature were used to populate the model. Drug acquisition, administration, and event costs were considered. RESULTS: Over 3 years, 61 additional patients reached their LDL-C goal in scenario 2, compared with scenario 1 (770 vs. 709, respectively), at an increased cost of $637,000 ($1,714,000 vs. $1,077,000, respectively). The additional per member per month (PMPM) cost of scenario 2 to the MHC plan was $0.02. When the cost of managing CV events was accounted for, the budget impact decreased to $634,000. CONCLUSIONS: Although the model has some limitations, it highlights the value of appropriate prescribing of statins. Initiating high-risk hyperlipidemic patients on rosuvastatin may increase the number of patients reaching LDL-C goals (defined in NCEP guidelines) at a relatively modest increase in PMPM cost to a MHC plan, despite the low cost of generic statins. PCV31 BUDGET IMPACT ANALYSIS OF INTRODUCING TICAGRELOR FOR THE TREATMENT OF ACUTE CORONARY SYNDROME INTO THE PUBLIC HEALTH CARE SECTOR OF HONG KONG Lee KK, Wu DB Monash University Sunway campus, Selangor, Malaysia
OBJECTIVES: Ticagrelor (TG) is a new oral platelet inhibitor with improved therapeutic effect and safety profile than clopidogrel. Yet it is not listed in the public hospital formulary of Hong Kong, hence suitable patients do not have general access to it. A budget impact analysis would thus help provide evidence to assist local budget holders in decision making processes. METHODS: A budget impact model was built to allow assessment of the budgetary impact to the local health care system from a government perspective if TG is introduced into the local market. The scenarios adopted were world with and without TG. A hypothetical cohort of 16,000 patients with acute coronary syndrome (ACS) was used as the population. Proportion of ACS events was estimated using HK-specific values. Sources of drug and DRGs costs were from the local public hospital authority as released in 2011. Market shares of TG as compared to clopidogrel (branded) for world without and with TG over a 5-year period were assumed to be 0% and 10-25% (with 5% increment/year) respectively. RESULTS: Over a 5-year period, the budget impact of using TG was estimated to range from 1.18% (year-1) to 3.21% (year-5) if TG was introduced. The actual extra cost per patient was estimated to range from HKD423 (USD54, 1USD⫽7.8HKD) in year-1 to HKD1,135 (USD146) in year-5. Deterministic sensitivity analysis performed suggested that proportions of bleeding between the 2 drugs and drug cost are the most influential variables. The drug acqusition costs were partially offset by improved therapetic outcomes, reduction in side effects and shortened hospital stay. CONCLUSIONS: Results of the present budget impact analysis suggest that introducing TG into the market
A117
of Hong Kong would only have minimal effect on the health care budget. Budget holders should consider TG as an option to clopidogrel in view of its better therapeutic effects and safety profile. PCV32 HEALTH RESOURCE UTILIZATION OF PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION VERSUS PULMONARY ATERIAL HYPERTENSION– RESULTS OF A RETROSPECTIVE STUDY IN SIX EUROPEAN COUNTRIES Schweikert B1, Pittrow D2, Gabriel A3, Berg J4, Sikirica M5 1 OptumInsight, Munich, Germany, 2Technical University Dresden, Dresden, Germany, 3Bayer Pharma AG, Wuppertal, Germany, 4OptumInsight, Stockholm, Sweden, 5Bayer Pharma AG, Berlin, Germany
OBJECTIVES: To describe and compare health resource utilization and related costs of patients with chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) in six European countries. METHODS: We reviewed medical charts from patients diagnosed with CTEPH or PAH and treated with PAH-specific therapy: Endothelin-receptor antagonists (ERA), prostacyclin analogues (PA) or PDE5-inhibitors (PDEi). Data on demographic and clinical characteristics, PAH-medication, and health resource utilization were retrospectively abstracted from patients’ medical records at specialized PH treatment centers across six European countries. Resource utilization was valued using country-specific unit costs; descriptive statistical analyses were performed. RESULTS: Twenty one hospitals documented 405 patients (120 in CTEPH and 285 in PAH). CTEPH patients were older with a mean age of 67.5 ⫾12.1 years versus 55.3 ⫾15.6 years for PAH patients. In the CTEPH group, 60% were female (PAH 74.4%) and both groups were on average observed for 25.7 months (SD 10.2). At baseline, 59.2% of CTEPH patients received ERA (PAH 53%), 5.8% PA (PAH 5.0%), and 34.2% PDE5i (PAH 37.0%). CTEPH patients experienced 1.8 ⫾2.2 hospitalizations per year accounting for 15.0 ⫾26.0 days in hospital, compared to PAH patients with 1.5 ⫾2.4 hospitalizations and 20.6 ⫾44.7 days, respectively. In both groups annual costs of PH medication was the predominant cost factor averaging €37,346 ⫾23,183 in CTEPH and €38,840 ⫾29,072 in PAH, followed by hospitalizations (CTEPH €4,554 ⫾7,894, PAH €6,254 ⫾€13,571) and concomitant medications (CTEPH €2,534 ⫾ €2505, PAH €1,301 ⫾ €1,514). Other health care resource items only accounted for marginal additional costs in both groups. CONCLUSIONS: These data show similar overall costs for patients with PAH and CTEPH. Although, for CTEPH off-label and without evidence from randomized trials, in both groups, PAH-specific medication was the predominant cost factor. CTEPH patients tended to have higher costs for concomitant medication whereas hospitalizations were more common in PAH. PCV33 STUDY ON HOSPITALIZATION COSTS FOR PATIENTS WITH ATRIAL FIBRILLATION RELATED STROKE IN CHINA Wu J1, Yang L1, Zhu G2 1 Peking University, Beijing, Beijing, China, 2Bayer Healthcare Company Ltd., Beijing, Beijing, China
OBJECTIVES: Atrial Fibrillation (AF) greatly increases the risk of stroke. AF-related stroke is associated with higher mortality, worse outcome and higher health care cost, which is substantial for patients and society. Few studies, however, of the costs of AF-related stroke were available in China. This study aimed to assess and compare the hospital costs and length-of-stay in patients with AF and AF-related stroke in China from payer’s perspective. METHODS: Data were extracted from the Basic Medical Insurance Databases in 2010. 385 patients were randomly selected by stratified two-stage sampling. All information of patient demographic characters, clinical and costs were collected for the analysis. The descriptive statistics was used to describe patients’ demographic characters, the hospital stay and the hospital costs. Univariate and multivariable analyses were also used in the data analysis. RESULTS: Total 385 patients (mean age 70.6 years; 51.4% male) were evaluated, 59.0% of patients with AF and 41.0% of patients with AF-related stroke. The mean length-of-stay was 14.2 days (11.9 days AF and 17.5 days AF related stroke; P ⬍ 0.001); the mean total cost was 17630.42 (median: 9323.25, IQR: 5086.8720193.43): 17734.93 (median: 6891.92, IQR: 3898.78-20751.16) with AF and 17480.27 (median: 11975.32, IQR: 7863.3-19941.85) with AF-related stroke (P⬍0.001). The multiple linear regressions showed that the hospital cost of AF-related stroke was 81% higher than the hospital cost of AF. Patients with basic medical insurance for urban employees had 39.6% higher costs than those with basic medical insurance for urban residents (P⬍0.001). Patients from tertiary hospitals had 97.8% higher costs than those from primary hospitals; (P⬍0.001) and patients from municipalities had 58.0% higher costs than those from prefecture-level cities; (P⬍0.01). CONCLUSIONS: Patients with AF-related stroke is associated with significantly higher hospital costs compared with those with AF. It implied that stroke prevention in AF may have potential cost savings. PCV34 COST AND TREATMENT DURATION FOR ACUTE MYOCARDIAL INFARCTION IN SOUTH EAST ASIA Azmi S1, Aljunid S2, Goh A1, Muhammad nur A2, Hamzah SM3, Ahmed Z3, Sulong S3 1 Azmi Burhani Consulting Sdn Bhd, Petaling Jaya, Selangor, Malaysia, 2United Nations University International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia, 3UKM Medical Centre, Kuala Lumpur, Kuala Lumpur, Malaysia
OBJECTIVES: The lack of data has presented a challenge to perform pharmacoeconomic research in Asia. However, efforts have been made to make cost data available and this study presents newly available data from clinical costing databases in Malaysia, Indonesia and the Philippines. The objective is to determine the length of stay and treatment cost per episode of acute myocardial infarction (MI). METHODS:
OBJECTIVES: To examine the association of missed diagnoses with patient, ED, and hospital characteristics using administrative data METHODS: We conducted a retrospective analysis of missed stroke diagnosis using linked inpatient discharge and ED visit records from the 2009 HCUP State Inpatient Databases (SID) and 2008 and 2009 HCUP State Emergency Department Databases (SEDD). This study was set in inpatient facilities and emergency departments in nine states (CA, FL, HI, MA, MO, NE, NY, SC, TN). We identified patients who were admitted for stroke and had a “treat and release” ED visit in the prior 30 days for a benign headache or dizziness. We excluded stroke admissions for patients under 18 years and for certain other admissions (not occurring through the ED; occurring in facilities with fewer than seven total stroke admissions during 2009; and with missing covariate values). RESULTS: Males (OR⫽0.75; p ⬍0.001) and older individuals (compared to 18-44, 45-64: OR⫽0.43; 65-74: OR⫽0.28; 75⫹: OR⫽0.19; p⬍.001) had lower odds, while Blacks (OR⫽1.17; p⬍.03), Asian/Pacific Islanders (OR⫽1.29; p⬍0.03), and Hispanics (OR⫽1.30; p⬍0.001) had higher odds of a missed stroke diagnosis. Medicare (OR⫽0.66; p ⬍.001) and Medicaid (OR⫽0.70; p ⬍0.001) patients had lower odds of a missed diagnosis compared to privately-insured patients. Non-teaching hospitals (OR⫽1.45; p⬍0.002) and hospitals with low volume (OR⫽1.57; p⬍0.008) had higher odds of a missed diagnosis. CONCLUSIONS: Physicians in the ED who are evaluating patients with headache and dizziness might want to be more attuned to the possibility of stroke in women, younger patients, and nonwhite patients. CARDIOVASCULAR DISORDERS – Cost Studies PCV30 ANALYSIS OF GENERIC SIMVASTATIN AND ATORVASTATIN VERSUS BRANDED ROSUVASTATIN IN HYPERLIPIDEMIA PATIENTS: A BUDGET IMPACT MODEL FROM A MANAGED CARE ORGANIZATION PERSPECTIVE IN THE UNITED STATES Ruff L1, Montouchet C1, Balu S2 1 Medaxial Group, London, UK, 2AstraZeneca Pharmaceuticals LP, Wilmington, DE, USA
OBJECTIVES: Hyperlipidemic patients at risk of cardiovascular (CV) events who receive simvastatin or atorvastatin as a first-line treatment may be less likely to meet low-density lipoprotein cholesterol (LDL-C) goals and thus more likely to experience CV events than patients who initiate on rosuvastatin. A deterministic model was developed to estimate the budget impact over 3 years of initiating high-risk patients in a hypothetical managed health care (MHC) plan on rosuvastatin rather than simvastatin or atorvastatin. METHODS: Among 1,000,000 health plan members aged ⱖ18 years, 1,000 patients (0.1%) were assumed to initiate statins. The average baseline LDL-C level was 160 mg/dL. Two scenarios were modeled: in scenario 1 all patients were initiated on simvastatin or atorvastatin and titrated to a higher dose, or switched to atorvastatin (if initiated on simvastatin) or rosuvastatin; in scenario 2, 50% of the 530 high-risk patients – based on National Cholesterol Education Program (NCEP) guidelines – were initiated on rosuvastatin. Product labeling, clinical trial results, national prescription claims data, and published literature were used to populate the model. Drug acquisition, administration, and event costs were considered. RESULTS: Over 3 years, 61 additional patients reached their LDL-C goal in scenario 2, compared with scenario 1 (770 vs. 709, respectively), at an increased cost of $637,000 ($1,714,000 vs. $1,077,000, respectively). The additional per member per month (PMPM) cost of scenario 2 to the MHC plan was $0.02. When the cost of managing CV events was accounted for, the budget impact decreased to $634,000. CONCLUSIONS: Although the model has some limitations, it highlights the value of appropriate prescribing of statins. Initiating high-risk hyperlipidemic patients on rosuvastatin may increase the number of patients reaching LDL-C goals (defined in NCEP guidelines) at a relatively modest increase in PMPM cost to a MHC plan, despite the low cost of generic statins. PCV31 BUDGET IMPACT ANALYSIS OF INTRODUCING TICAGRELOR FOR THE TREATMENT OF ACUTE CORONARY SYNDROME INTO THE PUBLIC HEALTH CARE SECTOR OF HONG KONG Lee KK, Wu DB Monash University Sunway campus, Selangor, Malaysia
OBJECTIVES: Ticagrelor (TG) is a new oral platelet inhibitor with improved therapeutic effect and safety profile than clopidogrel. Yet it is not listed in the public hospital formulary of Hong Kong, hence suitable patients do not have general access to it. A budget impact analysis would thus help provide evidence to assist local budget holders in decision making processes. METHODS: A budget impact model was built to allow assessment of the budgetary impact to the local health care system from a government perspective if TG is introduced into the local market. The scenarios adopted were world with and without TG. A hypothetical cohort of 16,000 patients with acute coronary syndrome (ACS) was used as the population. Proportion of ACS events was estimated using HK-specific values. Sources of drug and DRGs costs were from the local public hospital authority as released in 2011. Market shares of TG as compared to clopidogrel (branded) for world without and with TG over a 5-year period were assumed to be 0% and 10-25% (with 5% increment/year) respectively. RESULTS: Over a 5-year period, the budget impact of using TG was estimated to range from 1.18% (year-1) to 3.21% (year-5) if TG was introduced. The actual extra cost per patient was estimated to range from HKD423 (USD54, 1USD⫽7.8HKD) in year-1 to HKD1,135 (USD146) in year-5. Deterministic sensitivity analysis performed suggested that proportions of bleeding between the 2 drugs and drug cost are the most influential variables. The drug acqusition costs were partially offset by improved therapetic outcomes, reduction in side effects and shortened hospital stay. CONCLUSIONS: Results of the present budget impact analysis suggest that introducing TG into the market
A117
of Hong Kong would only have minimal effect on the health care budget. Budget holders should consider TG as an option to clopidogrel in view of its better therapeutic effects and safety profile. PCV32 HEALTH RESOURCE UTILIZATION OF PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION VERSUS PULMONARY ATERIAL HYPERTENSION– RESULTS OF A RETROSPECTIVE STUDY IN SIX EUROPEAN COUNTRIES Schweikert B1, Pittrow D2, Gabriel A3, Berg J4, Sikirica M5 1 OptumInsight, Munich, Germany, 2Technical University Dresden, Dresden, Germany, 3Bayer Pharma AG, Wuppertal, Germany, 4OptumInsight, Stockholm, Sweden, 5Bayer Pharma AG, Berlin, Germany
OBJECTIVES: To describe and compare health resource utilization and related costs of patients with chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) in six European countries. METHODS: We reviewed medical charts from patients diagnosed with CTEPH or PAH and treated with PAH-specific therapy: Endothelin-receptor antagonists (ERA), prostacyclin analogues (PA) or PDE5-inhibitors (PDEi). Data on demographic and clinical characteristics, PAH-medication, and health resource utilization were retrospectively abstracted from patients’ medical records at specialized PH treatment centers across six European countries. Resource utilization was valued using country-specific unit costs; descriptive statistical analyses were performed. RESULTS: Twenty one hospitals documented 405 patients (120 in CTEPH and 285 in PAH). CTEPH patients were older with a mean age of 67.5 ⫾12.1 years versus 55.3 ⫾15.6 years for PAH patients. In the CTEPH group, 60% were female (PAH 74.4%) and both groups were on average observed for 25.7 months (SD 10.2). At baseline, 59.2% of CTEPH patients received ERA (PAH 53%), 5.8% PA (PAH 5.0%), and 34.2% PDE5i (PAH 37.0%). CTEPH patients experienced 1.8 ⫾2.2 hospitalizations per year accounting for 15.0 ⫾26.0 days in hospital, compared to PAH patients with 1.5 ⫾2.4 hospitalizations and 20.6 ⫾44.7 days, respectively. In both groups annual costs of PH medication was the predominant cost factor averaging €37,346 ⫾23,183 in CTEPH and €38,840 ⫾29,072 in PAH, followed by hospitalizations (CTEPH €4,554 ⫾7,894, PAH €6,254 ⫾€13,571) and concomitant medications (CTEPH €2,534 ⫾ €2505, PAH €1,301 ⫾ €1,514). Other health care resource items only accounted for marginal additional costs in both groups. CONCLUSIONS: These data show similar overall costs for patients with PAH and CTEPH. Although, for CTEPH off-label and without evidence from randomized trials, in both groups, PAH-specific medication was the predominant cost factor. CTEPH patients tended to have higher costs for concomitant medication whereas hospitalizations were more common in PAH. PCV33 STUDY ON HOSPITALIZATION COSTS FOR PATIENTS WITH ATRIAL FIBRILLATION RELATED STROKE IN CHINA Wu J1, Yang L1, Zhu G2 1 Peking University, Beijing, Beijing, China, 2Bayer Healthcare Company Ltd., Beijing, Beijing, China
OBJECTIVES: Atrial Fibrillation (AF) greatly increases the risk of stroke. AF-related stroke is associated with higher mortality, worse outcome and higher health care cost, which is substantial for patients and society. Few studies, however, of the costs of AF-related stroke were available in China. This study aimed to assess and compare the hospital costs and length-of-stay in patients with AF and AF-related stroke in China from payer’s perspective. METHODS: Data were extracted from the Basic Medical Insurance Databases in 2010. 385 patients were randomly selected by stratified two-stage sampling. All information of patient demographic characters, clinical and costs were collected for the analysis. The descriptive statistics was used to describe patients’ demographic characters, the hospital stay and the hospital costs. Univariate and multivariable analyses were also used in the data analysis. RESULTS: Total 385 patients (mean age 70.6 years; 51.4% male) were evaluated, 59.0% of patients with AF and 41.0% of patients with AF-related stroke. The mean length-of-stay was 14.2 days (11.9 days AF and 17.5 days AF related stroke; P ⬍ 0.001); the mean total cost was 17630.42 (median: 9323.25, IQR: 5086.8720193.43): 17734.93 (median: 6891.92, IQR: 3898.78-20751.16) with AF and 17480.27 (median: 11975.32, IQR: 7863.3-19941.85) with AF-related stroke (P⬍0.001). The multiple linear regressions showed that the hospital cost of AF-related stroke was 81% higher than the hospital cost of AF. Patients with basic medical insurance for urban employees had 39.6% higher costs than those with basic medical insurance for urban residents (P⬍0.001). Patients from tertiary hospitals had 97.8% higher costs than those from primary hospitals; (P⬍0.001) and patients from municipalities had 58.0% higher costs than those from prefecture-level cities; (P⬍0.01). CONCLUSIONS: Patients with AF-related stroke is associated with significantly higher hospital costs compared with those with AF. It implied that stroke prevention in AF may have potential cost savings. PCV34 COST AND TREATMENT DURATION FOR ACUTE MYOCARDIAL INFARCTION IN SOUTH EAST ASIA Azmi S1, Aljunid S2, Goh A1, Muhammad nur A2, Hamzah SM3, Ahmed Z3, Sulong S3 1 Azmi Burhani Consulting Sdn Bhd, Petaling Jaya, Selangor, Malaysia, 2United Nations University International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia, 3UKM Medical Centre, Kuala Lumpur, Kuala Lumpur, Malaysia
OBJECTIVES: The lack of data has presented a challenge to perform pharmacoeconomic research in Asia. However, efforts have been made to make cost data available and this study presents newly available data from clinical costing databases in Malaysia, Indonesia and the Philippines. The objective is to determine the length of stay and treatment cost per episode of acute myocardial infarction (MI). METHODS: